DECEMBER 2011 UPDATE
Lame Duck Session to Include Healthcare Bills
The so-called lame duck session of New Jersey’s 214th Legislature exploded onto the scene in the middle of November, with Senate and Assembly committees attending to legislators’ last minute wish lists including a large number of health policy measures. With just a few committee days left before the houses commence their final voting sessions, the fate of several MSNJ priorities is starting to come into focus. Healthcare bills that facing recent or imminent action include:
A-4185 (Quijano, D – Union)
Summary: Requires certain disclosures by health care professionals
Position: Support
After a 10 year period in which the legislature expanded the scopes of nursing, optometry, chiropractic, genetic counseling, podiatry, and physical therapy (and apologies to all the paraprofessionals we forgot to mention), it’s nearly impossible for people to know for sure who their “doctor” really is. A-4185 seeks to remedy this by requiring providers to disclose exactly what kind of provider they are (our regrets to all you orthopedic chiropractic physicians out there). This bill is now pending on the Assembly floor.
A-3754 (Greenwald, D – Camden)
OLS Summary: Provides credit against ambulatory care facility assessment liability for value of unreimbursed care provided to hospital charity care patients.
Position: Support
After nearly two years of aggressive lobbying, organized medicine is finally seeing some movement on this measure which would allow physician owners of ambulatory facilities to deduct the value of their charity care from their gross receipts tax liability. It’s not a panacea, but this bill—which is on now pending on the Assembly floor—would at least acknowledge the incredible injustice of taxing doctors to pay for the very care they provide.
A-3480 (Ramos, D – Hudson) / S-2395 (Vitale, D – Middlesex)
Summary: “Revised State Medical Examiner Act”
Position: Support
This legislation establishes the Office of the Chief State Medical Examiner (CSME) in, but not of, the Department of Health and Senior Services (DHSS) to replace the Office of the State Medical Examiner in the Department of Law and Public Safety (DLPS). More importantly, it establishes uniform statewide standards for County Medical Examiners and uniform criteria for requiring a medicolegal death investigations, including requiring investigations for deaths inside psychiatric facilities. This bill is pending on the Assembly floor and widely expected to be released by the Senate Budget Committee at its next meeting.
A-3100 (Johnson, D – Bergen) / S-2282 (Weinberg, D – Bergen)
Summary: Provides inmates comprehensive medical discharge summary before release
Position: Support
In 2009 the legislature passed the “Fair Release and Reentry Act” with the intention of ensuring that inmates leave our prisons with the proper tools to effectively reenter society. Unfortunately, one of those tools included a prisoner’s full medical record which is a bit unwieldy and ultimately not helpful to physicians at the point of initial contact. Making matters worse, the Department of Corrections does not allow for the redaction of mental health notes that would typically occur in the private sector as per SBME regulations, opening up the potential for destabilization in the event that someone reads the frank, unedited comments of a prison psychiatrist. To fix this problem, A-3100 and S-2282 would provide that prisoners leave with the more-helpful discharge summary while retaining the right to retrieve their full medical records through the normal channels. Both bills have been released by committee and are pending on the floor of their respective houses.
A-3378 (Schaer, D – Passaic) / S-2372 (Vitale, D – Middlesex)
OLS Summary: “Healthcare Transparency and Disclosure Act”
Position: Seek Amendments
The health policy debate in 2010 and 2011 has in large part been dominated by efforts to change the way Out-of-Network care is provided and paid for, but both of these bills are now bottled up in the Senate Commerce Committee, which is unlikely to release anything in the lame-duck, though one never knows. If the bills don’t pass this year, look for a renewed effort next year by the insurance lobby, inspired to Senator Vitale’s return to the Health Committee Chairmanship.
A-3579 (Riley, D – Gloucester) / S-2397 (Madden, D – Gloucester)
OLS Summary: Establishes and enhances certain insurance fraud prevention measures.
Position: Oppose
Property and casualty insurers are engaged in an aggressive, national effort to enhance state insurance fraud laws and arm their own investigators with the tools they claim are necessary to weed out unethical arrangements between individuals, personal injury attorneys, and certain healthcare providers. And while organized medicine won’t stand in the way of efforts to get the bad guys, the provisions in A-3579 and S-2397 could potentially aggravate an already unfortunate state of affairs in which health insurers are exploiting a loophole in New Jersey’s Health Claims Authorizations, Processing, and Payment Act that allows them to make unfair assumptions and frivolous allegations of fraud to underpay physicians submitting claims in good faith. Until that potential unintended circumstance is resolved, it is unlikely that this measure will pass.
S-2780 (Vitale, D – Middlesex)
OLS Summary: Requires surgical practices to be licensed by DHSS as ambulatory care facilities.
Position: Monitor
This legislation would require Single Room Surgical Practices to be licensed by the Department of Health and Senior Services as ambulatory care facilities. It passed the Senate in June 2011 with sweeping amendments aimed at addressing MSNJ’s concerns, and the Assembly Health Committee released it with even broader exemptions.
REGULATIONS
(In order of Progress, Most to Least)
Proposed: PIP Reform
The New Jersey Department of Banking & Insurance has proposed amendments to its rules governing Personal Injury Protection coverage in auto insurance policies. Proposed reforms include:
- revisions to the PIP fee schedule;
- requiring a uniform internal dispute resolution process for all insurers; and
- rules for the calculation of attorneys’ fees by arbitrators.
Additionally, the Department indicated the new rules will establish a clearer path for auto insurers to access health insurers’ networks, including the in-network fee schedules, and offer incentives for consumers to receive their care from participating providers.
MSNJ has expressed our concern over the apparent establishment of “silent PIP networks” and the impact that may have on practices’ current payer mixes. We will continue to monitor the situation closely and work to ensure that any new regulations do not irreparably harm New Jersey’s healthcare environment.
Proposed: Scope of Chiropractic
The Board of Chiropractic has proposed new regulations pursuant to their scope of practice legislation that was enacted in 2010 and we’re shocked, shocked that they are attempting to expand their scope even further. While this relatively new proposal is still under review, one notable discrepancy is the Board’s effort to allow chiropractors to perform school physicals despite the legislature’s very clear rejection of that provision in the recently enacted bill.
MSNJ opposed this attempt to expand the scope of chiropractic, and we will be working very hard in both the Division of Consumer Affairs and the Governor’s office to ensure that the regulations are consistent with the law.
Pre-Proposal: Fair Contracts
The New Jersey Department of Banking & Insurance has been holding a series of pre-proposal stakeholder meetings in anticipation of proposed “fair contracts” rules, which were originally proposed in 2009 but never adopted. While it is not expected that all elements of the 2009 proposal will be included, MSNJ does anticipate some relief from practices like enforcing “Most Favored Nation” clauses and unilateral amendments to contract terms.
MSNJ appreciated the Department’s revisiting of this important initiative and particularly thanks the Governor’s Counsel, Jeff Chiesa, and his entire team, for their attention to this matter and dedication to making New Jersey a better place to practice medicine.